Thursday, August 21, 2014

Not all patients with Irregular cycles have PCOD

Many doctors and gynecologists misdiagnose and mismanage patients with irregular cycles. Most of them seem to automatically jump to the conclusion that any young patient with irregular cycle has PCOD . While it is true that the commonest cause of anovulation is polycystic ovarian disease , there are some unfortunate young women whose irregular cycles are because of poor ovarian reserve.

While gynecologists will think of this diagnosis when they deal with older women, they fail to consider this possibility in younger women. The problem is that once the woman has been labeled as having PCOD, doctors refuse to think about alterative possibilities.

This is heartbreaking, because it’s actually quite easy to differentiate between the two. Women with PCOD have large ovaries with increased central stroma and with multiple small cysts on ultrasound scan. Women with poor ovarian reserve can also have cysts, but these are fewer in number and the ovarian stroma is not increased. However, unless the ultrasound scan is done by a doctor who is careful about continuing the number of antral follicles, it’s easy to jump to the wrong diagnosis. Sadly, when most gynecologists see ovarian cysts being reported in a young patient with irregular cycles, they assume this means she has PCOD.

It’s also easy to differentiate between the two by doing blood tests to check levels of the reproductive hormones, FSH, LH and AMH. PCOD patients have a high AMH level; and their LH:FSH ratio is increased, with the LH typically being twice as much as the FSH level. Patients with poor ovarian reserve, by contrast, have low AMH levels, and a high FSH:LH ratio.

The irony is that once the doctor has a preconceived notion that this woman has PCO , it’s hard for her to change this diagnostic label, and she receives the wrong treatment for many years, until she gets a second opinion.

The wrong treatment ends up wasting a lot of time and money ; and when the patient finally realizes that they were misdiagnosed , they are angry and resentful and can't understand why so many different doctors ( including the sonographers ) couldn’t make the right diagnosis.

Even worse, many of these patients are then “ treated “ with ovarian drilling. This actually reduces their ovarian reserve even more, which means the chances of these patients getting pregnant even after IVF drop dramatically !

The problem is that once a patient has been mis-labelled, most doctors will not take the time and trouble to dig down deeper and find out whether the original diagnosis was correct or not. This is why patients need to do their own homework for themselves , because if you don't have the right diagnosis , you are not likely to get the right treatment.